Savoie, Vincent Paul NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Vincent Paul Savoie Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/29/2020 59 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death nicNatural Cause Accident ❑Homicide Suicide Undetermined Pending
(Wj Circumstances Investigation
QMedical Certifier Name Title
Gamal Khalifa MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 52
Burial Date Cemetery,Crematory or Facility Name
01/31/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town, New York
❑Donation
Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
Q
Date Point of
to Transportation
�
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/31/2020 Registrar of Vital Statistics Tp&it,gn mw Curtis(EYectronicalySyned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
E-
wDate of Dispositions Place of Disposition tie
ess/
W
IX (section) (loin tuber (grave number)
aName of Sexton or Person in Cha ge of Prem' es
Z (please print)
W Signature Title �T
DOH-1555(07/18)p t of 2
i L
Public Health Law Sec. 4145(2b) 13 3 0 3
Receipt
i
Human remains of k delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#